APTA Code Of Ethics Model

APTA Core Ethics and the RIPS Model

The APTA Code of Ethics and Standards for Practice has been my moral compass and my premise in having a sound practice of physical therapy.

I am no stranger to the many changes that has occurred in healthcare throughout the 14 years of my practice here in the United States. The tasks of delivering patient care have become challenging and at times complicated by ethical dilemmas brought by either medical insurance, pressure from management, or time constraints. I have worked for companies and facilities who value their reimbursements more than the patient’s needs. Granted that health care has become a business, our patients and their families cannot be just numbers that we should meet. Time and time again,
I have seen patients being scheduled for overly high treatment minutes just to meet the resource utilization groups (RUG) level. In the course of my practice, I have learned to be a voice for my patients and stand up for the appropriate treatment minutes by informing my rehab program manager of the frequency and length of sessions that I foresee my patient truly needs.

To name a few of other scenarios that I have faced in the skilled nursing facility setting that made me rethink are the preset fifteen minutes of billing for the service based evaluation, the fifteen minute treatment limit for Medicare A patients on a weekend session due to shortage of staffing, or the treatment of patient who will be in a day or two will be under hospice care.
Though I have been told it should be up to my discretion for these situations, why are therapists still being continually placed in this position to be tested to conform or
not?

Life is a balancing act. Our personal lives and profession coincides with each other demanding our utmost attention. As health care professionals, we took an oath to enact the duties and responsibilities that embodies the physical therapy profession. As such, we have obligations towards our family. Just like this scenario that took place in my facility where a lapse of judgment in my colleague’s decision and course of action took a wrong turn. A family member was curious and approached the therapy team asking if and when her mother with dementia had received therapy that day. The therapist who supposedly treated the patient has already gone home to take her son for a scheduled doctor’s visit. Upon checking the billing in the computer system, the rehab program manager noted that there was a half an hour of treatment billed. The inquisition to what time the patient was seen revealed that the therapist has documented a treatment time wherein she was not physically present in the building. Further investigation also revealed that the therapist falsified her clock out time.

the primary realm in the above scenario is the patient because whether the service was actually rendered or not, the patient was inappropriately billed.
The witnesses need to have moral courage (individual process) to speak up and be the patient’s advocate because this is a clear cut violation of patient’s rights and is a problem (situation) for all parties involved. The major stakeholders in this scenario are the physical therapists, facility and insurance company. Taking action which the therapists did by telling their manager made sure that this fraudulent action stops right away before it gets worse. There were laws broken and ethical principles 2, 4, 5 and 7 in the are compromised as well as the core values professional duty, integrity, accountability. It was no doubt that the answer is yes to all the right-versus-wrong tests. In all things considered, the patient’s rights needed to be protected. The employee was let go and the billing for the said patient was retracted. Since it was never found out when this behavior started, no further corrections in previous billings were made. To prevent future acts of fraud to occur, a company-wide review of the policies regarding proper input of billing in real time and accurate punch time in and out was
performed.

From this situation, was there anything else that should have been done? In reflecting about the specific scenario above, how likely can emotions and social connections override the actions or outcome?

To my colleagues, here is the link to Pennsylvania Practice Act I am generally familiar with the State Practice Act of Pennsylvania. Every time a new situation comes up, revisiting it helps me get more acquainted on the specifics of the PA rules and regulations. I look forward in finding out how this differs from yours. Thank you.
-Reigner